What does aetna pay orthopedics groups in IL?

Median published rate is 88.3% of Medicare across 561 NPIs (September 2026 files).

Data as of the September 2026 payer files.

Across 200 procedure codes and 1 payer, the median published rate is 104 percent of locality-adjusted Medicare in the September 2026 payer files. Aetna is the only payer with enough confirmed NPIs to publish here, at 104 percent of Medicare, so there is no spread to compare yet. The best-covered row rests on 561 confirmed NPIs, and any combination under five is withheld rather than shown thin. These are contracted amounts the payer published, not what a practice was paid, and every row clears the ghost-rate filter, so each NPI counted here actually billed the code in the Medicare utilization file.

Published rates

What does aetna pay orthopedics groups in IL?
Payer	Code	Site	n	p25	p50	p75	% of Medicare
Aetna	99213	professional	561	17.88	65.18	98.86	88.3%
Aetna	99214	professional	527	32.5	94.41	147.86	89.3%
Aetna	99204	professional	446	45	128.9	200.02	91.1%
Aetna	99203	professional	440	36.57	89	128.47	89.2%
Aetna	20610	professional	409	10.98	41.16	84.51	119.1%
Aetna	73030	professional	248	15.43	29.31	44.05	149.3%
Aetna	73502	professional	242	18.18	44.82	62.32	147.9%
Aetna	27447	professional	210	263.53	936.86	2021.23	158.7%
Aetna	73562	professional	208	15.71	34.52	54.29	151%
Aetna	73564	professional	208	18.72	39.31	62.07	148.4%
Aetna	99212	professional	193	12.87	37.95	59.42	82.6%
Aetna	27130	professional	166	263.84	923.45	1962.3	158.5%
Aetna	72100	professional	123	18.18	31.36	49.56	156.5%
Aetna	20550	professional	117	20	53.27	82.09	126.9%
Aetna	73110	professional	117	14.62	37.89	55.94	151.1%
Aetna	73721	professional	107	114.31	237.6	342.75	173.3%
Aetna	20605	professional	105	21.29	59.6	78.38	128.7%
Aetna	73560	professional	105	13.45	26.31	44.3	143.8%
Aetna	20600	professional	104	20.28	56.78	74.2	123.9%
Aetna	73130	professional	100	14.62	35.15	48.78	153.2%
Aetna	20611	professional	95	15.99	59.96	118.71	111.8%
Aetna	99215	professional	92	45.3	146.9	235.74	88.9%
Aetna	73221	professional	88	114.9	244	345.52	173.6%
Aetna	73080	professional	82	14.33	35.33	47.33	161%
Aetna	73610	professional	79	14.33	43.69	55.25	162.5%
Aetna	72148	professional	78	125.07	212.04	326.3	174.6%
Aetna	64721	professional	76	219.29	532.58	777.8	137.8%
Aetna	23472	professional	75	295.96	1109.86	2277.52	155%
Aetna	73630	professional	70	13.77	40.89	50.76	163%
Aetna	26055	professional	67	280.17	636.24	763.99	103.8%
Aetna	27245	professional	65	280.09	942.41	1973.29	158.5%
Aetna	72040	professional	63	17.89	37.89	55.65	161.3%
Aetna	20526	professional	59	52.97	109.47	120.06	127.5%
Aetna	97110	professional	59	30.57	36.99	37.16	125.3%
Aetna	29827	professional	56	520.92	1399.31	1842.5	157.7%
Aetna	97140	professional	51	28.15	34.11	34.22	120.8%
Aetna	72110	professional	48	19.05	39.1	59.6	136.5%
Aetna	63047	professional	43	234.46	820.6	1749.2	128.8%
Aetna	77002	professional	43	50.02	108.88	162.49	153%
Aetna	73552	professional	42	15.57	42.18	52.9	162.3%
Aetna	29826	professional	41	99.58	258.76	297.86	171.6%
Aetna	27236	professional	40	284.54	916.76	1894.62	139%
Aetna	99205	professional	40	81.35	209.63	352.21	91.2%
Aetna	22633	professional	37	583.69	1454.87	2973.89	102.3%
Aetna	29823	professional	34	149.4	455.23	940.8	135.9%
Aetna	72141	professional	34	124.78	210.9	326.87	174.2%
Aetna	97530	professional	34	46.12	46.91	46.91	131.4%
Aetna	22853	professional	32	55.67	187.58	387.19	159.8%
Aetna	29828	professional	32	1195.44	1417.47	1605.2	129%
Aetna	29824	professional	31	338.94	862.22	1194.13	136.8%
Aetna	99202	professional	29	27.46	61.27	88.3	90.3%
Aetna	97112	professional	28	30.68	42.62	42.62	127.8%
Aetna	29881	professional	26	110.65	382.9	912.22	117.3%
Aetna	72070	professional	26	15.8	31.6	45.1	156.6%
Aetna	25600	professional	25	124.75	254.02	606.57	338.9%
Aetna	64718	professional	25	149.95	696.55	993.28	148.3%
Aetna	73501	professional	25	16.92	34.27	47.02	151.3%
Aetna	20551	professional	24	9.66	44.78	82.09	185.5%
Aetna	27446	professional	24	235.36	853.19	1824.05	21.9%
Aetna	20552	professional	23	12.68	44.45	77.41	238%
Aetna	22612	professional	23	508.93	1261.25	2544.67	20.3%
Aetna	25609	professional	23	1370.19	1758.39	1842.14	37.2%
Aetna	29880	professional	22	282.38	859.19	998.86	129.3%
Aetna	63048	professional	22	39.3	112.08	307.21	161.4%
Aetna	20680	professional	21	198.3	468.61	886.03	106.4%
Aetna	22551	professional	21	1379.17	2290.95	3011.31	31.6%
Aetna	22842	professional	21	164.83	520.16	1251.28	166.7%
Aetna	27487	professional	21	336.13	1148.99	1786.26	20%
Aetna	20606	professional	19	25.81	67.18	121.69	183.8%
Aetna	73565	professional	19	16.44	39.39	59.28	141.1%
Aetna	22558	professional	18	374.97	1117.75	2094.03	12%
Aetna	63030	professional	18	394.65	1115.55	1693.54	48.8%
Aetna	73590	professional	18	13.23	37.52	48.93	163.1%
Aetna	20604	professional	17	16.34	58.53	117.73	215.1%
Aetna	26160	professional	17	181.63	605.42	847.58	111.8%
Aetna	28470	professional	17	105.47	280.28	420.42	371%
Aetna	29876	professional	17	234.11	501.03	1120.27	106.1%
Aetna	62323	professional	17	45.31	147.99	300.9	103.9%
Aetna	64483	professional	17	44.21	128.3	274.46	96.9%
Aetna	64719	professional	16	144.96	458.17	769.02	123.1%
Aetna	14040	professional	15	318.4	637.37	1177.8	104.1%
Aetna	15823	professional	15	175.73	427.4	1033.44	99.8%
Aetna	20553	professional	15	24.16	72.23	200.65	1161.5%
Aetna	25608	professional	15	847.13	1369.68	1803.5	30.9%
Aetna	27134	professional	15	575.1	1369.67	1935.34	21%
Aetna	27486	professional	15	329.05	1079.77	1878.5	28.1%
Aetna	27786	professional	15	123.62	307.13	597.2	493.4%
Aetna	43762	professional	15	59.08	140.11	533.04	424.3%
Aetna	45380	professional	15	115.71	366.78	759.04	133.3%
Aetna	45385	professional	15	116.6	407.97	813.72	135.7%
Aetna	55866	professional	15	361.5	1012.5	1863.5	36.4%
Aetna	62321	professional	15	74.58	207.85	484.08	136.5%
Aetna	63046	professional	15	530.53	1156.25	1863.5	50.4%
Aetna	64450	professional	15	26.85	83.18	245.51	719.3%
Aetna	64490	professional	15	212.91	367.55	1156	103.3%
Aetna	64493	professional	15	191.88	327.3	1156	101%
Aetna	64635	professional	15	151.67	399.23	660.76	98%
Aetna	66821	professional	15	131.76	299.15	563.41	274.5%
Aetna	66982	professional	15	203.42	763.34	1240.51	103.5%
Aetna	66984	professional	15	151.15	557.42	950.09	103.5%
Aetna	66986	professional	15	246.16	924.6	1504.2	122.7%
Aetna	66991	professional	15	241.95	747.82	1435.5	35.8%
Aetna	67904	professional	15	257.15	713.82	1185.37	132.2%
Aetna	G0121	professional	15	138.73	270	687.28	156%
Aetna	10021	professional	14	32.43	95.15	346.97	945.5%
Aetna	11641	professional	14	88.91	180.26	471.93	563.3%
Aetna	11642	professional	14	103	205.99	633.99	517.3%
Aetna	11643	professional	14	104.77	218.68	732.38	466.5%
Aetna	14041	professional	14	366.13	781.5	1514.5	124.8%
Aetna	14060	professional	14	311.18	658.11	1295.72	106.6%
Aetna	14061	professional	14	415.92	842	1506.5	118.9%
Aetna	21315	professional	14	51.91	122.26	247.1	117.5%
Aetna	21320	professional	14	75.77	139.8	368.68	51.5%
Aetna	21555	professional	14	141.23	328.22	807.95	126.2%
Aetna	22514	professional	14	1173.21	1863.5	3614.61	53.7%
Aetna	22600	professional	14	596.81	1102.5	2178.8	14.6%
Aetna	22614	professional	14	84.51	316.92	718.35	169.1%
Aetna	22800	professional	14	608.8	1102.5	2246.21	14.2%
Aetna	22802	professional	14	904.8	1685.17	3115.66	16.8%
Aetna	22804	professional	14	1011.41	1878.5	3579.68	18%
Aetna	22849	professional	14	573.86	1102.5	2147.36	20.8%
Aetna	22855	professional	14	554.71	1144.5	1878.5	50.3%
Aetna	22856	professional	14	1776.28	2218.9	2922.06	17%
Aetna	25605	professional	14	172.07	475.2	1053.03	131.9%
Aetna	25607	professional	14	757.55	1213.08	1803.5	28.1%
Aetna	27279	professional	14	382.11	926.39	1461.35	10.5%
Aetna	27280	professional	14	662.86	1263.75	1887.38	13.6%
Aetna	29806	professional	14	291.56	826.84	1654.1	44.2%
Aetna	29807	professional	14	285.07	818	1640.93	44.4%
Aetna	29822	professional	14	152.59	484.09	1000.31	73%
Aetna	29825	professional	14	247.3	600.53	1056.34	74.5%
Aetna	29870	professional	14	217.2	482.83	915.27	53.9%
Aetna	29873	professional	14	195.07	477.56	1025.47	73%
Aetna	29874	professional	14	226.47	547.98	1117.6	81.4%
Aetna	29875	professional	14	179.71	444.65	980.75	75.6%
Aetna	29877	professional	14	174.14	556.52	1141.58	87.9%
Aetna	29879	professional	14	237.51	592.97	1174.55	75.2%
Aetna	29882	professional	14	244.87	617.67	1210.98	76.5%
Aetna	29888	professional	14	266.78	794.9	1479.64	30.7%
Aetna	29889	professional	14	512.68	941	1814.27	16.7%
Aetna	29891	professional	14	282.46	676.19	1343.57	89.3%
Aetna	29914	professional	14	1077.53	1701.88	1801.14	46.1%
Aetna	29915	professional	14	1096.15	1708.5	2116	46.2%
Aetna	29916	professional	14	1113.46	1708.5	1829.34	46.2%
Aetna	30130	professional	14	184.85	481.22	877.96	69%
Aetna	30140	professional	14	95.55	234.88	736.06	54.3%
Aetna	30420	professional	14	507.24	1238.19	1863.5	61.6%
Aetna	30465	professional	14	268.16	1021.69	1804.3	64.3%
Aetna	30520	professional	14	263.83	668.21	1229.64	88.6%
Aetna	30801	professional	14	88.83	181.52	470.37	97.7%
Aetna	30802	professional	14	95.68	236.39	568.55	120%
Aetna	30903	professional	14	74.55	182.76	498.9	888.1%
Aetna	30905	professional	14	101.35	275.25	677.91	1075.3%
Aetna	30906	professional	14	94.49	284.97	681.56	610.7%
Aetna	31231	professional	14	54.55	142.05	477.59	688.3%
Aetna	31237	professional	14	83.5	234.59	646.3	92.9%
Aetna	31238	professional	14	83.63	235.15	673.7	105.8%
Aetna	31239	professional	14	205.21	674.87	1181	82.7%
Aetna	31240	professional	14	63.76	180.13	619.78	105.8%
Aetna	31253	professional	14	170.49	569.35	1136.59	49.7%
Aetna	31254	professional	14	106.53	383.88	884.32	43.3%
Aetna	31255	professional	14	99.75	368.14	1064.72	49.3%
Aetna	31256	professional	14	66.55	204.66	770.06	55.9%
Aetna	31257	professional	14	151.93	507.01	1012.88	47.2%
Aetna	31259	professional	14	161.11	537.03	1297.52	53%
Aetna	31267	professional	14	89.74	301.57	864.32	39.7%
Aetna	31276	professional	14	106.83	429.36	948.75	48.1%
Aetna	31288	professional	14	84.44	266.57	797.7	38.8%
Aetna	31295	professional	14	1055.5	1514.5	1565.03	48.8%
Aetna	31296	professional	14	1055.5	1514.5	1598.96	101.2%
Aetna	31297	professional	14	1039.26	1514.5	1541.2	48.7%
Aetna	31298	professional	14	576.99	1408.59	1923.3	73.4%
Aetna	31535	professional	14	70.4	214.94	725.06	52.6%
Aetna	31536	professional	14	77.81	239.01	780.14	55.9%
Aetna	31541	professional	14	97.48	299.4	891.79	62.6%
Aetna	31575	professional	14	41.64	118.94	448.24	792%
Aetna	31600	professional	14	115.4	365.02	944.25	70%
Aetna	32555	professional	14	76.44	254.8	696	229.5%
Aetna	33207	professional	14	217.53	582.78	1180.63	17.7%
Aetna	33208	professional	14	142.33	551.95	1177.61	19.4%
Aetna	33216	professional	14	135.11	450.37	941	19.9%
Aetna	33228	professional	14	161.51	431.22	880.4	13.6%
Aetna	33241	professional	14	106.25	260.52	691.69	50.7%
Aetna	33249	professional	14	250.09	968.39	1711.64	7.7%
Aetna	33263	professional	14	175.6	470.45	966.27	5.7%
Aetna	33264	professional	14	182.4	489.5	874.7	4.1%
Aetna	33270	professional	14	254.01	682.39	1137.81	5.6%
Aetna	33274	professional	14	172.99	586.98	1153.26	8.2%
Aetna	36561	professional	14	179.36	675.85	1185.66	73.7%
Aetna	36571	professional	14	305.68	842	1432.29	90.3%
Aetna	36573	professional	14	81.42	271.42	696	121.7%
Aetna	36580	professional	14	51.54	154.03	546.77	97.9%
Aetna	36581	professional	14	136.46	486.51	961.47	57.6%
Aetna	36589	professional	14	79.62	156.55	414.57	183.3%
Aetna	36590	professional	14	92.93	216.67	541.5	100.7%
Aetna	36593	professional	14	59.05	105.23	1215	2103.1%
Aetna	37265	professional	14	941	1717	4068.41	57.2%
Aetna	37273	professional	14	1524.69	2497.69	7623.43	16.6%
Aetna	38220	professional	14	47.86	124.75	507.47	624.9%
Aetna	38221	professional	14	45.78	127.5	495.73	504.8%

Median rate by payer, percent of Medicare

Solid line 100% of Medicare.

How this is measured

Rates come from each payer's published Transparency in Coverage machine-readable file, filtered to this specialty's codes and to NPIs the CMS Medicare utilization file shows billing that code. Percentiles are computed per payer, code and site of service across those NPIs, then divided by the locality-adjusted Medicare amount for the same code and place. Full methodology.

Payer files: 2026-09

Questions

Is this what the practice was paid?

No. These are contracted rates as published by the payer, not allowed or paid amounts.

Why are some cells blank?

Ghost rates are removed using Medicare utilization. A row appears only if that NPI billed the code.

What is an episode total?

Professional plus facility when both exist. We never average them or invent a total from one side.

Saran Siva

Co-founder & CTO, Insight Health · September 2026 files